NHS Lothian: a new framework for public engagement

May 26, 2022 by No Comments | Category Guest blog, Planning for participation

A number of factors came together late in 2020 to create the right conditions for the introduction of a new strategic framework to support engagement work across the NHS Lothian area. Around 850,000 people are served by the health and care system across Edinburgh, East, West and Mid Lothian. These factors included:

  • The introduction by Healthcare Improvement Scotland of their new quality framework, which followed their updated guidance on engaging with people for public bodies (Planning With People). This brought fresh impetus and focus to engagement in health and care work across Scotland and replacing ten year old previous guidance.
  • Internal audit findings in NHS Lothian in 2019 which highlighted a need for the organisation to enhance its engagement profile, resources and staff support.

The aim of the new framework was to create the conditions where effective engagement work could thrive throughout the Lothian area. And in thriving, properly inform the future direction, development and operation of services.

It  is a statement of intent designed to gather support and commitment from the leaders of the health board, but also all the Integrated Joint Boards in the Lothian area (West Lothian, Midlothian, East Lothian and Edinburgh City). This was nothing less than a blueprint for a cultural shift throughout the health system in the Lothians. One that had at its heart the concept of partnership with those the system was designed to serve.

A Framework to inspire change

So much for grand intentions – they do not necessarily achieve results! In recognition of this, the document itself sets out very clearly the organisational building blocks which need to be in place for the culture shift described above.

Where did these building blocks come from? With resources tight and priorities across the health system fiercely competitive, it was important to establish a credible and authoritative structure for the Framework.

Plenty of literature exists to illustrate the general value of good engagement work and its impact. There are also lots of tool kits and practical guides telling you how to get good results. But when it comes to system-wide change to incorporate engagement as a routine, mainstream part of organisational and service level improvement and development, precious little exists – at least in terms of practical measures to achieve such change.

What was needed was something that constituted action planning whilst maintaining a strategic approach, which is not an easy balance to achieve.

First Principles – Agenda 21, Healthy Cities and the World Health Organisation

Admittedly, this is a leap. World Health Organisation worldwide change programmes as the foundation for NHS Lothian’s new Engagement Framework?

In fact, the community roots movement – including participation – is at the heart of these programmes.  They were designed to promote health, equality and economic regeneration alongside sustainable, environmental development. The Healthy Cities programme, for example, has, as a key driver:

  • Cities should demonstrate increased public participation in the decision making processes that affect health in the city, thereby contributing to the empowerment of local people. (Designation Criterion B5)

In addition, Agenda 21, which focusses on sustainable development, starts out from a strong participatory position:

“…development will not be environmentally, economically or socially sustainable without the active participation of communities.”

A lot of literature and research effort has been generated by these programmes and the detailed report Community Participation in local health and sustainable development brings together the learning from the programmes about community participation and engagement.

A key finding, frequently returned to throughout the report, is the importance to successful engagement of organisational strategy and commitment. The World Health Organisation (WHO) is direct and uncompromising on this point:

 “A strategic and coordinated approach to community participation requires a number of preconditions, including commitment, understanding and openness to change, competencies and resources. Without these the effectiveness of community participation will be limited and communities may be left feeling let down and cheated.”

The preconditions mentioned here are particularly useful when constructing fresh organisational strategy. WHO has used the wide ranging, in depth experience of these global change programmes to isolate key concepts needed to foster a culture that embraces public engagement. This is undoubtedly a solid and authoritative base upon which to build. The principles are not time sensitive and are as relevant today as when they were produced in 2002.

WHO preconditions to NHS Lothian building blocks

The preconditions from the report mentioned above translate well into an organisational strategy for engagement. They have become the building blocks for creating strong engagement infrastructure across Lothian’s health and care system. They form the core of NHS Lothian’s public engagement framework, ensuring this document is strategic and aspirational while also providing practical navigation milestones towards an integrated approach to engagement.

The turmoil wrought on health and care services by the pandemic has made progress difficult. But the emergence of our health system from the worst of that crisis is arguably a propitious time for the kind of change the Framework supports.

The three building blocks: Enabling conditions, which includes leadership, values and shared purpose, resources and a prepared and supported workforce; Capacity development which includes developing cultural competence, defining roles and responsibilities and building collaborative structures; Implementation and support, which includes early engagement interventions at a strategic planning level, development of toolkits to support staff, and building engagement networks across the region.

The three building blocks from NHS Lothian’s Public Engagement Strategy

Large and complex organisations will not change overnight. But already we are seeing enhanced approaches to engagement within NHS Lothian as it looks to open up wide ranging and inclusive conversations with its public partners. These partners includes patients and other service users, groups with special needs, voluntary sector partners, staff and the general public. These conversations are about the future direction of services through the development of its new strategic plan.

Nevertheless, expectations about fast results appears high on the list of challenges when it comes to organisational culture change. When things do not visibly change in the short term, it is easy to become disillusioned and demotivated. WHO’s unequivocal stance on this is hard to argue with:

“The culture of non-participation, by which agencies and professional groups have preserved power and made decisions of behalf of communities, takes time to change.”

These are early days. As a goal, a Lothian health and care system that is comfortable with the huge added value public engagement can bring is a worthy prize, especially as it seeks to navigate the difficult waters that lie ahead. The journey is long, but it is underway.

Find out more

Follow NHS Lothian on Twitter. See how the public can influence NHS Lothian’s work at their Get Involved hub.

Contact Simon to continue the conversation about the work NHS Lothian are doing to further public engagement at

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